Prosthetics and Orthotics International最新文献

Background: Limb rotation within prosthetic sockets significantly affects the comfort, gait, and stability of lower-limb amputees. Despite advancements in suspension systems, empirical evidence validating their rotational control remains limited. This study aims to systematically compare the rotational resistance of 3 prosthetic suspension systems-Pin-Lock, Suction, and Hook-and-Loop (HOLO)-under controlled conditions, addressing a critical gap in prosthetic design research.

Methods: We evaluate the rotational resistance of 3 different prosthetic suspension systems-Pin-Lock, Suction, and HOLO-under varying axial loads (0/40/80 kg) and both (medial and lateral) rotational directions. Using a custom-designed mock limb and identical 3D-printed sockets, each suspension system was evaluated using a materials testing machine. The angular displacement of the limb inside each socket was measured under a constant torque ramp of 1 Nm/s, up to a maximum torque of 8.5 Nm.

Results: The HOLO system (9.67° at 80 kg) showed significantly less rotation than the Pin-Lock (13.34° at 80 kg, p < 0.01) and Suction (14.42° at 80 kg, p < 0.01) systems. The medial rotation was 10.5% and 26.9% less than lateral rotation for Pin-Lock and HOLO systems, respectively, and 25.5% greater for Suction (all p < 0.01). Increasing axial loads reduced rotation for the Pin-Lock system only.

Conclusions: This is the first study to measure the effectiveness of different prosthetic suspension systems using a representative mock limb. The results show that there are significant differences between the systems, highlighting the need to consider a user's activity level and rotational demands in prosthetic provision.

This scoping review provides an overview of studies comparing the (cost-)effectiveness of shape capture and socket design techniques for transtibial and transfemoral prostheses. The review compares manual, hybrid, and digital methods, identifies the measurement tools used, and assesses their methodological quality. Effectiveness refers to clinical and functional outcomes such as socket fit, comfort, and user function, whereas cost-effectiveness reflects the balance between resource use and these outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 5 databases (PubMed, Embase, Web of Science, CINAHL, and Cochrane) were systematically searched. Studies involving humans with transtibial or transfemoral prostheses that compared at least 2 of the 3 methods and reported (cost-)effectiveness outcomes were included. Of 556 articles screened, 20 met the inclusion criteria (497 participants). Sixteen studies evaluated transtibial prostheses and 4 transfemoral prostheses. Manual and hybrid methods were compared in 14 studies, and digital and manual methods in 6, whereas none compared hybrid and digital methods. Eighteen studies were rated as low quality, 2 as moderate, and none as high. Effectiveness constructs mainly covered the International Classification of Functioning, Disability and Health domains "Body functions & Body structures" and "Activities and participation," but many were not clearly defined within this framework. Reported outcomes most often addressed production time, number of socket attempts, and socket fit or comfort. Overall, evidence remains limited and inconsistent, with a clear lack of direct comparisons between digital and hybrid techniques. Tentatively, hybrid and digital approaches may improve efficiency and comfort compared with manual methods, but robust, standardized research is needed to confirm these effects.

Background: Routine health care data remain underused for enhancing care quality, safety, and cost-effectiveness, and for research. Little is known about data collection and outcome measurement (OM) in English prosthetic services. This insight could inform health care quality improvement and future nationwide data initiatives.

Objective: To examine data collection and OM practice undertaken during implementation of the Microprocessor Controlled Prosthetic Knee Clinical Commissioning policy in English prosthetic services.

Study design: Nationwide survey of practice.

Methods: An online survey was developed and piloted with clinicians working in English prosthetic rehabilitation centers. The survey was deployed to all 35 of England's prosthetic services. Centers were asked to complete one survey per center.

Results: Twenty-two centers completed the survey. Twenty of 21 patient data items were collected at rates >80%, whereas 5 of the 6 core outcomes were captured at rates exceeding 90%. Variation was observed in the scoring and administration methods of OMs across centers, limiting comparison of scores. Clinically, patient outcome data were most often used to inform individual decision making regarding microprocessor knee prescription (95%). However, 50% of centers suggested OMs needed to be more useful and relevant. Forty-one percent of centers do not collate data across patients.

Conclusions: The consistency of types of data captured demonstrate the importance of this data for implementation of the National Health Service England microprocessor knee policy. This work has identified several areas of variability, such as OM administration and collation of data, that present operational and educational challenges for the clinical use of routine health care data and OMs. These challenges need to be considered for those implementing future service provision policies or aiming to develop a national prosthetic data collection initiative.

Background: Spinal bracing remains the gold standard for conservative management of adolescent idiopathic scoliosis (AIS). However, poor adherence often limits treatment efficacy. The development of a brace that enhances compliance while maintaining sufficient corrective force is crucial.

Objectives: This study aimed to develop and evaluate the effectiveness of a novel semi-rigid brace for AIS based on wearing time and correction rate.

Study design: Multicenter prospective observational study.

Methods: We enrolled patients who met the following Scoliosis Research Society criteria for brace treatment: (1) confirmed AIS diagnosis, (2) Risser sign ≤2, (3) Cobb angle between 25° and 40°, (4) age ≥10 years, and (5) single-curve pattern. Wearing time was objectively measured over 180 d using embedded temperature sensors. Correction rates were assessed at initiation and after 12 months or more.

Results: A total of 60 patients with AIS were included. Among them, 24 had thoracic curves, and 36 had thoracolumbar/lumbar curves. The mean daily wearing time was 16.3 h for thoracic curves and 18.2 h for thoracolumbar/lumbar curves. The median initial correction rate was 32% for thoracic curves and 45% for thoracolumbar/lumbar curves. After 12 months or more, the median correction rate was 20% and 48%, respectively. The dropout rate was 5%, and no severe skin complications were observed.

Conclusions: The novel semi-rigid brace demonstrated high compliance and effective curve correction over 12 months. These findings support its potential as a comfortable and effective conservative treatment option for patients with AIS.

Background: Demographic and clinical characteristic data for children with major lower limb absence provide insight for rehabilitation professionals and policy makers. This paper describes demographics for children accessing 3 prosthetic rehabilitation centers in Cambodia. It is hypothesized that associations exist between the demographic data and reason for limb absence and time to first prosthetic access.

Methods: A retrospective analysis of 71 physical casefiles was conducted for children aged 5-17 years in 3 centers affiliated with Exceed Worldwide and the Department of Prosthetics and Orthotics Cambodia between 2005 and 2023. Demographic data were extracted for children with major lower limb absence proximal to the ankle joint. Descriptive and inferential statistics were applied with the significance level set at ( p < 0.05).

Results: Most children were male (67.6%) and 55.3% of prostheses provided were for transtibial. The most common cause was trauma (59.2%) primarily because of road traffic accidents (71.4%). There was a significant association between reason for limb absence with sex ( p = 0.004) and time to prosthetic access ( p = 0.011). Reason for limb absence ( p = 0.016) and age of acquired limb absence ( p = 0.003) were significantly associated with the type of prosthesis supplied.

Conclusions: Traumatic amputation was the most common, with more males and transfemoral children presenting with trauma than expected, necessitating further research into policies to reduce traumatic amputation and its subsequent proximal amputations. Time to first access was greater for congenital deficiencies necessitating future work to support early prosthetic use. The dataset provides clarity on a unique cohort requiring ongoing prosthetic care.

Limb trauma can result in decreased mobility, compensatory gait patterns, and pain. Carbon fiber custom dynamic orthoses (CDOs) include a cuff below the knee, posterior strut, and semi-rigid footplate. Custom dynamic orthoses alter foot loading within the footplate, but the effects of cuff design are not well understood. The purpose of this study was to determine the effect of cuff design on foot loading. Five individuals without, and 1 individual with, lower limb injury completed testing without a CDO and with a CDO with 3 different cuff designs. Loadsol insoles (Novel Electronics, St Paul, MN) were placed under the foot in the shoe or in the CDO footplate to measure peak forces and force impulse of the total foot, hindfoot, midfoot, and forefoot. No significant differences were observed with post-hoc paired sample t tests ( p > 0.05). Compared to walking without an orthosis, peak forces decreased in the CDO (11%-16% hindfoot, 20%-36% midfoot, 21%-29% forefoot). Effect sizes were medium to large when comparing with and without a CDO ( d = 0.56-1.97) and small to large when comparing between cuffs ( d = 0.24-2.99). Hindfoot force impulse increased with all cuffs (14%-29%), with medium effect sizes ( d = 0.51-0.78). The patellar tendon bearing cuff with ratcheting closure mechanism generally resulted in the greatest changes in peak forces and force impulse. Study data demonstrate the potential importance of cuff design on foot loading. The largest effects were generally observed with use of a patellar tendon bearing design with ratcheting closure mechanism.

Background and objectives: Neuromuscular diseases cause hypotonia and axial weakness, leading to a high incidence of severe, progressive scoliosis usually initially treated by bracing. The Garches brace is the most widely used brace in France for children with severe congenital neuromuscular disease. We compared 2 methods for Garches brace manufacturing, 3D scan acquisition, and plaster casting, in efficacy, acceptability, and tolerance.

Study design and method: We conducted a retrospective, noninterventional single-center study on 101 braces made between January 2013 and October 2023 for 32 children. Changes in Cobb angle with the brace, manufacturing delay, number of fittings, skin tolerance, daily wearing time, and time until brace replacement between plaster casting and 3D scan acquisition were tested. Semi-structured interviews collected professionals' opinions of the methods.

Results: Change in Cobb angle did not differ between the methods ( p = 0.169). Manufacturing delay was similar ( p = 0.657), as was the number of fittings ( p = 0.744) and number of skin disorders ( p = 0.596). Interviews with professionals highlighted the necessity to move on from plaster casting methods and emphasized the comfort provided to children and the improved work conditions brought by 3D scan acquisition.

Conclusion: Improved child comfort, combined with no significant difference in tolerance, lifespan, and effectiveness to plaster casting, supports the adoption of 3D scan acquisition for Garches brace manufacturing.

Introduction: Living with a lower limb amputation is a life-altering complication. This condition is often associated with a high prevalence of pressure ulcers and skin breakdown at the interface between the prosthetic socket and the residual limb. The purpose of this study was to describe a monofilament test method for identifying areas that lack protective sensation in individuals with transtibial amputation (TTA).

Methods: Fifteen males and 5 females with TTA were evaluated using a standard 5.07/10 g monofilament test, which was adapted to test sensation at 10 locations on the residual limb.

Results: Thirty-five percent of the participants experienced loss of protective sensation on their distal anterior tibial crest, 50% of the participants had absent sensation along their incision line, and 20% of the participants experienced loss of sensation at the center of the distal end of the limb. The test method showed excellent intrarater reliability (Kappa = 1).

Conclusions: Implementing a monofilament test is a reliable and practical option for practitioners to use in testing for loss of protective sensation in TTA because of the ease and speed of the test, as well as its low cost and potential for standardization.

Effective orthopedic care/rehabilitation for pediatric upper limb deficiencies (ULDs) requires understanding how function and prosthetic control progress as the child develops. Psychometrically sound outcome measures are imperative. This systematic review critically appraised the instruments available for assessing upper limb function among children with ULDs. PubMed, Embase, CINAHL, and Scopus were searched. Eligible studies evaluated instruments' validity, reliability, and/or responsiveness and included children under 18 years. Following PRISMA guidelines, multiple reviewers independently screened studies, extracted data, assessed risk of bias, and rated psychometrics and evidence quality by the COnsensus-based Standards for selection of health Measurement INstruments methodology. Reviewers screened 2513 studies; 19 reports describing 4 performance-based tests and 6 patient-reported outcome measures were included. An ideal outcome measure for pediatric ULDs does not yet exist. For clinicians/researchers seeking a standardized observational assessment, the Assessment of Capacity for Myoelectric Control (valid only for myoelectric prostheses) and Assisting Hand Assessment are the most promising options, showing the best feasibility and psychometrics. A modified Assisting Hand Assessment is under development for ULDs with or without prosthesis use. For clinicians/researchers seeking a more practical questionnaire that they can implement beyond the clinic, all existing options would benefit from revision and simplification. We provisionally recommend the 10-min, parent-reported Child Amputee Prosthetics Project-Functional Status Inventory. However, the preschooler version needs construct revisions, and all versions need reliability studies. Two well-known pediatric instruments, the Patient-Reported Outcomes Measurement Information System and Pediatric Outcomes Data Collection Instrument, are invalid for assessing upper limb function among patients with ULDs.